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NPI Code Detail

MEDICARE: REBECCA GLENN LMP

MEDICARE: REBECCA GLENN LMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172M00000XMechanotherapistMA 00021731WA

General Provider Information

NPI Number : 1265872667
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA GLENN LMP
Provider Business Mailing Address
First Line : 113 S PARKWAY AVE
Second Line :
City : BATTLE GROUND
State : WA
Zip : 98604-9294
Country : US
Telephone Number : 360-687-1781
Fax Number :
Provider Business Practice Location Address
First Line : 113 S PARKWAY AVE
Second Line :
City : BATTLE GROUND
State : WA
Zip : 98604-9294
Country : US
Telephone Number : 360-687-1781
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2013
Last Update Date : 06/28/2013

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Directions to “ REBECCA GLENN LMP” Practice Location

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